Hallux valgus and plantar pressure loading: the Framingham foot study

Background: Hallux valgus (HV), a common structural foot deformity, can cause foot pain and lead to limited mobility. The purpose of this study was to evaluate differences in plantar pressure and force during gait by HV status in a large population-based cohort of men and women. Methods: A trained examiner performed a validated physical examination on participants’ feet and recorded the presence of hallux valgus and other specific foot disorders. Each foot was classified into one of four mutually exclusive groups based on the foot examination. Foot groups were: (i) HV only, (ii) HV and at least one additional foot disorder (FD), (iii) no HV but at least one other FD, and (iv) neither HV nor FD (referent). Biomechanical data for both feet were collected using Tekscan Matscan. Foot posture during quiet standing, using modified arch index (MAI), and foot function during gait, using center of pressure excursion index (CPEI), were calculated per foot. Further, walking scans were masked into eight sub-regions using Novel Automask, and peak pressure and maximum force exerted in each region were calculated. Results: There were 3205 participants, contributing 6393 feet with complete foot exam data and valid biomechanical measurements. Participants with HV had lower hallucal loading and higher forces at lesser toes as well as higher MAI and lower CPEI values compared to the referent. Participants with HV and other FDs were also noted to have aberrant rearfoot forces and pressures. Conclusions: These results suggest that HV alters foot loading patterns and pressure profiles. Future work should investigate how these changes affect the risk of other foot and lower extremity ailments

The Nonlinear Relationship Between Gait Speed and Falls: The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston Study

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Correlations of clinical and laboratory measures of balance in older men and women: The MOBILIZE boston study

OBJECTIVE: Impaired balance is associated with falls in older adults. However, there is no accepted gold standard on how balance should be measured. Few studies have examined measures of postural sway and clinical balance concurrently in large samples of community-dwelling older adults. We examined the associations among four types of measures of laboratory- and clinic-based balance in a large population-based cohort of older adults. METHODS: We evaluated balance measures in the MOBILIZE Boston Study (276 men, 489 women, 64-97 years). Measures included: (1) laboratory-based anteroposterior (AP) path length and average sway speed, mediolateral (ML) average sway and root-mean-square, and area of ellipse postural sway; (2) Short Physical Performance Battery (SPPB); (3) Berg Balance Scale; and (4) one-leg stand. Spearman Rank Correlation Coefficients (r) were assessed among the balance measures. RESULTS: Area of ellipse sway was highly correlated with the ML sway measures (r \u3e0.9, p \u3c 0.0001), and sway speed was highly correlated with AP sway (r=0.97, p \u3c 0.0001). The Berg Balance Scale was highly correlated with SPPB (r=0.7, p\u3c0.001), and one-leg stand (r=0.8, p\u3c0.001). Correlations between the laboratory- and clinic-based balance measures were low but statistically significant (0.2 \u3c r \u3c 0.3, p\u3c0.0001). CONCLUSION: Clinic-based balance measures, and laboratory-based measures comparing area of ellipse with ML sways or sway speed with AP sway, are highly correlated. Clinic- with laboratory-based measures are less correlated. As both laboratory- and clinic-based measures inform balance in older adults but are not highly correlated with each other, future work should investigate the differences. (c) 2012 by the American College of Rheumatology